Opiate painkillers can be swallowed, injected, snorted, sucked or absorbed though the skin or bowel. They are used mainly to treat moderate to severe pain. This can range from relieving acute back pain, to use for broken bones, and for people who are being treated for cancer.

Most opiate painkillers are only available on prescription from a doctor or other prescriber. Some opiates at low doses, such as codeine, when combined with other analgesics like paracetamol, ibuprofen or aspirin are designed to be able to be bought over-the-counter in pharmacies. These combined medicines are used for treating severe headaches, period pains etc., which have not responded to simpler treatments.

Opiate painkillers carry warnings on the packs about the risk of addiction and advise that the non-prescription medicines should only be used for up to three days at a time without medical advice.

Physical health risks

An opiate painkiller that has been properly prescribed or has been obtained from your local pharmacy is subject to stringent controls, as with any other medicine, so you can be sure of its strength and that it has not been tampered with.

But you can't be sure about this with opiate painkillers that have been obtained from unreliable or illegal sources.

The risks associated with taking an opiate painkiller, especially in high dose, purchased from a source outside the legitimate supply chain (for example, a website – particularly if hosted overseas) may include:

constipation

itching

nausea and retching

lethargy

dizziness or fainting

in overdose, suppression of normal breathing, and risk of respiratory arrest (when you stop breathing altogether)

Certain opiate painkillers have additional specific non-opioid effects, which may be described by the prescriber, and will be described in the patient information leaflet.

Overuse of codeine when it is taken already combined with one of the simple analgesic drugs, can lead to paracetamol, aspirin or ibuprofen poisoning and even death. Whilst paracetamol, ibuprofen and aspirin may seem harmless in normal doses, they can cause really serious problems in high doses – with risks of kidney failure, liver failure, and of severe damage to, or bleeding from, the stomach, which can be fatal.

There is a greater risk of overdose and death if you are mixing opiate painkillers with other drugs that suppress breathing such as alcohol, benzodiazepines (like diazepam or Valium), and/or other opiate drugs. There's a particular risk of death due to inhaling vomit – because opiate painkillers can sedate you, can add to the risk of vomiting, and can stop you from coughing properly. The vomit blocks the airways or later leads to pneumonia.

In pregnancy, regularly having taken high doses of opiate painkillers for a continuous sustained period of time in the lead up to delivery can lead to withdrawal symptoms for the newborn baby.

For pregnant women who have been using substantial amounts of opiates daily for a period of time, it's not a good idea to stop using them suddenly without proper advice. This is because this might increase their risk of having a miscarriage or having a premature labour. Women in such circumstances should seek medical advice before stopping.

Injecting any opiate painkiller can do nasty damage to your veins and arteries, and this can lead to gangrene (death of body tissue, usually a finger, toe or a limb), blood clots/thromboses and to infections.

There are also risks from sharing needles, syringes and other equipment used for injecting – with the danger of developing serious tissue infections or sharing viral infections like hepatitis B, hepatitis C or HIV.

What is opiate/opioid painkillers cut with?

If the opiate painkiller has been prescribed properly as a medicine (alone or mixed with other drugs such as paracetamol or ibuprofen), or obtained properly from your local pharmacy, the purity will be very high and the doses consumed will be predictable.

If the opiate painkiller has been sourced illegally you cannot be sure what is in it and what effect it will have.

Is it dangerous to mix with other drugs?

Mixing any opiate painkillers with alcohol, or with other sedatives such as benzodiazepines, can have serious consequences: an overdose is more likely, and this can lead to a coma or respiratory failure and death.

Can you get addicted?

Yes, any opiate painkiller can be addictive and produce 'cravings' and a psychological desire to keep on using.

Although they are safe to take if you follow your prescriber’s/pharmacist's instructions, and take the recommended dosage for the time recommended, some people who have used opiate painkillers regularly for some time, have become dependent on them.

If opiate painkillers are taken primarily to get high or to manage psychological pain, the risk of becoming dependent on the drugs is greater.

Tolerance can also build, so that users have to take more just to get the same effects or to avoid unpleasant withdrawals. This is one of the reasons opiates can become ineffective for long-term chronic pain.

Additional law details

Strong opiate painkillers are only available on prescription and most are controlled under of the Misuse of Drugs Act and are classified as Class A or B drugs. So unless an opiate painkiller has been prescribed to you it’s illegal to have, it’s also illegal to give away or sell opiate painkillers. The Government is currently considering a recommendation to make tramadol illegal.

Depending on the circumstances, possession of a class A opiate painkiller which has not been prescribed for you, could get you community service or up to 7 years in prison and/or an unlimited fine. The unauthorised possession of a class B opiate painkiller, not prescribed, could get you community service or up to5 years in prison and/or an unlimited fine.

Depending on the circumstances, supplying someone else with a class A or B opiate painkiller, including your friends, could get you the maximum penalty of a jail sentence, ranging from 14 years to life and/or an unlimited fine.